Monday, September 15, 2014

A Deficiency of Nutrition Education in Medical Training

We do not need to wait for more studies on nutrition and health. Although additional research will add refinements to current knowledge, we need more action on what we already know.

A 2013 report on the state of US health identified dietary factors as the single most significant risk factor for disability and premature death. Despite the wealth of knowledge linking food and health, nutrition receives little attention in medical practice. The reason stems, in large part, form the severe deficiency of nutrition education at all levels of medical training to be described in this commentary.

The Lyon Mediterranean Diet Heart Study, published in 1999, showed a 72% reduction in cardiovascular events attributed to diet (an effect approximately twice that of most statin trials). A whole foods, plant-based diet low in refined carbohydrates and animal products has been proven to reverse coronary heart disease and confer potent protection against type 2 diabetes and cancer.

How has this knowledge affected medical education? A recent survey of medical schools revealed an average of fewer than 20 hours over 4 years devoted to nutrition education.

Nutrition education is in even shorter supply after medical school graduation. The Accreditation Committee of Graduate Medical Education fails to mention any requirement for nutrition for specialty training as a cardiologist. The same is true with their requirements for Internal Medicine residency training, from which many doctors go on to serve as primary care physicians.

Accordingly, physicians frequently lack substantive nutrition knowledge and counseling skills necessary to guide their patient. A recent study found that only 14% of resident physicians believed they were adequately trained to provide nutritional counseling. Paradoxically, patients believe otherwise. A survey of the public conducted by the American Dietetic Association in 2008 showed that 61% consider doctors to be “very credible” sources of nutrition information.

This is an excerpt from a commentary published in the American Journal of Medicine by several physicians. Dean Ornish, MD and Andrew T. Weil, MD are probably the most well-known of the group. I found this article when I ran across another commentary written by the lead author, Dr. Stephen Devries, a cardiologist at Northwestern University in Chicago. These comments were not picked up by mainstream media. I suspect Dr. Devries has decided to “push the envelope” by continuing to write on this subject, hoping physicians will eventually respond.

Both articles were directed toward physicians, not the general public. I admire the effort, but the only way to change the medical approach to nutrition is outside pressure, not internal dialogue.

Virtually every consult I have had with another physician about a common patient revolves around my credentials, not the treatment protocol. At first I thought they didn’t care what I was recommending, and there may be some truth to that initial thought. However, I soon realized they really didn’t know what I was talking about. They don’t know about essential fatty acids or genetic impairment of folic acid metabolism. They don’t understand the connection between diet and disease.

Clarity came to me one day when I was discussing my treatment plan with a neurologist. Our common patient had MS. He interrupted by dialog saying, “excuse me, I don’t mean to be rude, but what are your qualifications?” When I responded with “I have a diplomate in nutrition through studies at the University of Miami, Miller School of Medicine.” He replied, “OK doctor, do anything you want, I just needed to know you were credentialed.”

Don’t be part of the 61% of the public that believes physicians are authorities on nutrition. Do push your physician to become more knowledgeable on the subject. Ask the questions, just don’t trust the answers.

Source: American Journal of Medicine –April 19, 2014

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